Provider First Line Business Practice Location Address:
883 N HOWARD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21201-4605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-332-4666
Provider Business Practice Location Address Fax Number:
410-332-0298
Provider Enumeration Date:
11/28/2006